Here's something you don't read every day: force-feeding a hunger striker violates medical ethics.
Hmmm. So, preventing someone from starving to death is medically unethical? Wouldn't it be more unethical to let someone starve to death, even if it is their wish?
After all, suicide is against the law in this country.
Regardless of the odd dichotomy, the Associated Press reported Tuesday (emphasis added, h/t NBer allanf):
Military doctors violate medical ethics when they approve the force-feeding of hunger strikers at the U.S. prison camp at Guantanamo Bay, according to a commentary in a prestigious medical journal.
The doctors should attempt to prevent force-feeding by refusing to participate, the commentary's three authors write in Wednesday's Journal of the American Medical Association.
Fascinating. The article continued:
"In medicine, you can't force treatment on a person who doesn't give their voluntary informed consent," said Dr. Sondra Crosby of Boston University, one of the authors. "A military physician needs to be a physician first and a military officer second, in my opinion."
Interesting. Yet, is nutrition considered treatment, or one of life's necessities? Would doctors in a non-military hospital allow a patient in a non-vegetative state remove his or her feeding tube if it became clear that the patient was suicidal?
Regardless, the AP didn't do a very good job of identifying who Dr. Crosby was, as her bio at Boston University's website indicates that she is the "Director of Medical Services at the Boston Center for Refugee Health and Human Rights."
The AP conveniently ignored that affiliation, and chose not to address this Center at all (from the Center's website, emphasis added):
Through an innovative model of out-patient care, we provide comprehensive medical, mental health, and dental care-coordinated with legal and social services-to over 300 individuals from 67 countries each year. Interpreter services are available for over 30 languages to aid in the healing journey of each patient and their families.
The Center is a member of the National Consortium of Torture Treatment Programs and operates as an interdisciplinary collaboration among clinicians and experts from Boston Medical Center (Departments of Psychiatry, Medicine, Family Medicine, Pediatrics, Social Work, and Interpreter Services), Boston University (Schools of Medicine, Public Health, Dentistry, and Law), Global Lawyers and Physicians-a non-governmental organization, and the National Center for Post-Traumatic Stress Disorder.
MissionOur mission is to provide comprehensive health care for refugees and survivors of torture and related trauma, coordinated with legal aid and social services. We also exist to educate and train agencies and professionals who serve this patient population, to advocate for the promotion of health and human rights in the United States and worldwide, and to conduct clinical, epidemiological, and legal research for the better understanding and promotion of health and quality of life for survivors of torture and related trauma.
It would have been nice if the AP had informed readers that Crosby works for such an advocate, don't you agree?
As an aside, Crosby also doesn't like animal farms.
—Noel Sheppard is the Associate Editor of NewsBusters.
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Experimental procedure...
August 1, 2007 - 15:14 ET by rscamp13is what they called it in Terry Schiavo's case. I can't see forcing them to eat, besides it's very humane to starve and have your kidneys shut down because you dehydrate. Oh wait, they probably drink water.
So I guess we let them
August 1, 2007 - 16:51 ET by motherbeltSo I guess we let them starve. Until they start ordering in coffee with vanilla ice cream in it, or the Jamba Juice smoothies, like Cindy Sheehan.
Fasting, Moonbat-style
These terrorists are eager
August 1, 2007 - 15:33 ET by Senior ChiefThese terrorists are eager die to see the 72 virgins promised to them...so docs, let them starve! If they gain strength, they might kill you, and if our government let them out of prison, they'll go back to the battlefield and kill our troops. So docs, are you with us or against us? Just asking...
Senior Chief, Im all for
August 1, 2007 - 15:44 ET by bassndudeSenior Chief, Im all for feeding these terrorists. Force feed them pig fat for a year. If they insist on starving themselves to death, Im all for letting them do that to, but would make sure each one of them had a pig in his cell with him. :-)
Save a SeAL, club a liberal!!
They could just get the
August 1, 2007 - 15:51 ET by sarcasmoThey could just get the local Cubans to BBQ a nice pig upwind -- if it were me THAT would be torture. I'd probably want to commit a "hunger strike" on those Cubans' pig by the time it was halfway done. But Mark has informed me a while ago that despite my opinion that it's possibly the best smell in all the world, a pig being cooked actually does not smell good to all human beings (I'm blessed! Or my waistline is cursed!!). ;^)
JMR
Damned if you do...damned if
August 1, 2007 - 15:36 ET by bigtimerDamned if you do...damned if you don't.
In all cases, whatever
August 1, 2007 - 16:08 ET by DaMavIn all cases, whatever undermines the security of the United States is the common thread for these "human rights" clowns. It's transparent.
It's got nothing whatsoever to do with the rights of humans.
Let'em starve. Do you
August 1, 2007 - 17:42 ET by dabalLet'em starve. Do you really want to feed, clothe, and house these jerks for the rest of their natural lives?
The Hippocratic oath says "to do no harm". I'm pretty sure that means you shouldn't be injecting hydrochloric acid into their eyes. It's a little vague when it comes to someone who WANTS to die, a problem that was probably unheard of during the times of Hippocrates.
It's the doctors' call, not ours. I'd say putting food in the cell would all but eliminate the debate on this subject. If the prisoner has ready access to food, and still decides to starve to death, so be it. Cramming tubes down their throats involuntarily doesn't seem like the American thing to do, IMHO.
To libs, anything we do is wrong
August 1, 2007 - 17:58 ET by nkviking75They'd also gripe if we let them starve to death.
When you put the clowns in charge, don't be surprised if a circus breaks out.
Do Not Resuscitate (DNR)
August 1, 2007 - 18:05 ET by stratmanDo Not Resuscitate (DNR) orders have for some time included sections on fluids and parenteral (IV) or feeding tube nutrition. Patients/people deemed to be of sound mind can voluntarily choose to have one or more of these methods withheld under the provisions of the DNR order. If the person is not deemed psychologically fit to make the determination, or is unconscious before signing or indicating their DNR wishes, physicians are obliged to provide all care until either the patient can make the determination for themselves or a legal entity makes the decision for the patient.
The prevailing medical opinion is that withholding nutrition and fluids in the suitable patient will hasten their death without increasing suffering.
The prevailing medical opinion also states that a physician should ultimately respect a patient's wishes, as long as the patient is deemed psychologically fit, despite the physician's knowledge that the patient's actions may cause them harm. In other words, you can't force nutrition or fluids on a patient if they are psychologically fit to make their own decisions. To do otherwise would constitute battery on the physician's part.
The issue gets murky when the psychologically "fit" patient passes out from his hunger strike. An unconscious patient can no longer make determinations about their care, and so the physician may treat. Except the aspect of following the patient's wishes then comes into play. Also, prison patient's, including the one's in Gitmo, may be viewed by a different filter by officials, further muddying the ethics of treating or not.
The American Medical Associaction as a group is highly critical of the war, any war that is. They have been critical of the Bush administration. Things only get worse when you breakdown the AMA, or physician's in general, into individual physician opinions. There are some super activists in that mix with a deep resentment of the Bush administration.
There are also some very altruistic individuals as well as many that follow or defer to the concepts of the relatively new field of medical ethics. This is a good thing for patients, and, it allows for physicians to have guidelines to follow concerning some very difficult situations. However, the downside sometimes is a pendulum swinging very far to one side that can, at times, cause these ethicists to appear more fixated than Beach Boy Brian Wilson during his "in my room" phase. I would hypothesize that most medical ethicists are not fans of Bush either though that may have little bearing in their decision on patient rights.
The politics of Gitmo hunger strikers caused an opposite and in kind force response - forced feeding. The medical ethicists, not differentiating between prisoner or lawful citizen patient, demands the patient's wishes be respected. The military physician is stuck in the middle having taken an oath when entering the military and an oath when graduating from medical school. (Used to be the Hippocratic Oath, usually a Christian appropriate version minus the "gods" recitation, was pledged at graduation,but, nowadays, the yahoos feel it's too oppressive, unyeilding on abortion and euthanasia, and mysogynistic, so, they substitute a politically correct and abortion allowing oath. Isn't that special.)
I'd like to know how the military physicians respond to this dichotomy.
Killing them with kindness isn't working. Time to get scrappy with the Donkeys.
I'll have a lash.
August 1, 2007 - 21:39 ET by dervishFirst off, as is probably obvious to everyone, this has nothing to do with medicine and everything to do with politics. The ethical situation they're conflating with this is medical intervention to change or prolong a natural process. Assuming the patient to be in sound mind, he/she has a right to refuse treatment, and the physician should respect the refusal. Usually this only arises in treatment of terminal illness (where patients refuse treatments that often only delay the inevitable), but you have the right to refuse treatment for pneumonia or strep throat or blood loss if you wish. Your autonomy stops when it impinges on other people, of course -- you can be involuntarily treated for transmissible diseases, for example, as "TB Andy" recently demonstrated.
Suicide is a somewhat different issue. A healthy person who wants to kill himself is, a priori, assumed not to be in his right mind, and generally intervention is made to prevent him. Depressed people are prevented from suicide, against their will if necessary. People with anorexia nervosa are force-fed if necessary. It's only the romantic notion of political expression that changes this principle of preserving healthy life. If the writers of this article didn't think that politics was a valid reason for these guys killing themselves (not that they necessarily agreed with the politics, but I wonder), they'd be considered crazy and prevented. That's pretty squishy ethical ground, if you ask me.
War carries its own set of ethical principles, as evidenced by the obvious point that it's otherwise considered to be poor form to take up weapons and kill people you've never met. The boys at Gitmo are enemy combatants, and their attempted suicides are simply war by other means: they're attempting to adversely affect the U.S. military. No doubt they'd prefer to kill their guards, but since they can't, they'll try to embarrass or at least aggravate the guards by killing themselves instead (larger political fallout being an extra added benefit). It is not only the right but the duty of a soldier to prevent harm to his unit, regardless of whether s/he's a physician. If you prefer, you can equate force-feeding to forcible prevention of escape: same basic principle involved.
But it's glaringly obvious that this whole issue is being staged simply to put another anti-war article in the New York Times. As everyone in the medical field knows, putting down a nasogastric tube is considerably simpler than even starting an IV. It's about as complicated as putting the oil dipstick back in your car. I guarantee you that the greenest 91A medic in the Army can be taught to do it in about 90 seconds, and the feedings themselves come neatly packaged in pop-top cans, so any physicians that find this distasteful can just get out of the way.
Asymmetrical Warfare
August 1, 2007 - 23:43 ET by stratmandervish:
Excellent summation of the situation. It seems we have written companion pieces - my intro to medical ethics 101 and your succinct interpretation of patient rights and current events as related to the article.
The Gitmo enemy combatants are indeed waging asymmetrical warfare with their hunger strikes. As such, countermoves should be utilized to neutralize the combatants' tactics. In this case it would be nasogastric tube feedings. Even an adolescent can place an NG tube, though I wouldn't want them to be pissed at me when they place it.
If the Gitmo enemy combatants are depressed and are using hunger strikes in an attempt to commit suicide then ethics would require tube feedings.
Six of one, half a dozen of the other, Either way, the hunger strikers are fed.
Unfortunately, the media will use whatever is done at Gitmo, force feedings to prevent death or hunger strikes to cause death, to promote a Liberal agenda at the expense of endangering American lives worldwide.
Considering the velvet glove handling of Obama's recent machismo (or is that "macheesemo") about invading Pakistan, does anyone think the MSM would approach the hunger strike story the same way with a Dem as president?
I don't think so.
Killing them with kindness isn't working. Time to get scrappy with the Donkeys.
Or...
August 1, 2007 - 19:11 ET by JeffWeimerLet them die and we'll have another thing to hold over your head...You starved them, it's torture!
Yes
August 1, 2007 - 19:50 ET by drillanwrNot allowing the prisoners to starve themselves WOULD put a damper on those darned human rights groups' Death Toll At Gitmo tallies.
Not to be...
August 1, 2007 - 21:19 ET by BigBNot to be a D$$k or anything but, they probably have no more useful information to give...starve!! Or mebbe a trip back to where you came from...or mebbe we'll let some one else have a crack at you...Jordan for instance?? Or mebbe just a lead injection to help you on yer way to meet yer 72 sweethearts....
Starve you pricks....
Now, this might sting just a little bit.....
}}}----> Hunger Strikers
August 2, 2007 - 08:52 ET by Cool ArrowHeeeey! Look at the photo. How can all these yoyo's be facing East?
Guess we've inflicted them with bipolar disorder, huh? Can you do this with nothing more than a measly ol' weather machine, Karl?
Nobody's thought of all the
August 2, 2007 - 11:34 ET by Shooter1002Nobody's thought of all the extra falafel. C'mon, I break my butt trying to get the falafel order right and now this! Who's gonna eat all that extra falafel? Who dammit? Who? Who? Who? Answer me?
Nobody thinks of me? Do they? I'm just the falafel lady? Right?
Why is it so cold in here?